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Joseph A Gil, Avi D Goodman, Justin Kleiner, Robin N Kamal, Laurence C Baker, Edward Akelman
BACKGROUND: The Patient Protection and Affordable Care Act (ACA) was approved in 2010, substantially altering the economics of providing and receiving healthcare services in the United States. One of the primary goals of this legislation was to expand insurance coverage for under- and uninsured residents. Our objective was to examine the effect of the ACA on the insurance status of patients at a safety net clinic. Our institution houses a safety net clinic that provides the dominant majority of orthopaedic care for uninsured patients in our state...
May 2018: Clinical Orthopaedics and related Research
Yan Li, Ming-Xi Zhu, Si-Hua Qi
Previous studies have shown that marital status is an independent prognostic factor for survival in several types of cancer. In this study, we investigated the effects of marital status on survival outcomes among renal cell carcinoma (RCC) patients.We identified patients diagnosed with RCC between 1973 and 2013 from the Surveillance, Epidemiology and End Results (SEER) database. Kaplan-Meier analysis and Cox regression were used to identify the effects of marital status on overall survival (OS) and cancer-specific survival (CSS)...
April 2018: Medicine (Baltimore)
Paul A Manner
No abstract text is available yet for this article.
May 2018: Clinical Orthopaedics and related Research
Sayeh S Nikpay, Margaret G Tebbs, Emily H Castellanos
BACKGROUND: The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. METHODS: Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid...
April 17, 2018: Cancer
Tianyi Swartz, Faisal Jehan, Andrew Tang, Lynn Gries, Muhammad Zeeshan, Narong Kulvatunyou, Mohammad Hamidi, Terence O'Keeffe, Bellal Joseph
INTRODUCTION: Health-literacy is emerging focus of interest in public health and is evolving as an important component of national health policy. Low-health-literacy (LHL) is associated with poor outcomes. We aimed to identify factors associated with LHL and its relationship with health outcomes in trauma patients. METHODS: We prospectively enrolled all adult trauma patients (age>18y) in our analysis. Patients were surveyed at discharge and followed up at 4-weeks post-discharge...
April 13, 2018: Journal of Trauma and Acute Care Surgery
Giselle K Perez, Anne C Kirchhoff, Christopher Recklitis, Kevin R Krull, Karen A Kuhlthau, Paul C Nathan, Julia Rabin, Gregory T Armstrong, Wendy Leisenring, Leslie L Robison, Elyse R Park
PURPOSE: To describe and compare the prevalence of mental health access, preference, and use among pediatric cancer survivors and their siblings. To identify factors associated with mental health access and use among survivors. METHODS: Six hundred ninety-eight survivors in the Childhood Cancer Survivor Study (median age = 39.4; median years from diagnosis = 30.8) and 210 siblings (median age = 40.4) were surveyed. Outcomes included having mental health insurance coverage, delaying care due to cost, perceived value of mental health benefits, and visiting a mental health provider in the past year...
April 15, 2018: Journal of Cancer Survivorship: Research and Practice
Joshua Wassink
Background: Despite an expansive body of research on health and access to medical care among Mexican immigrants in the United States, research on return migrants focuses primarily on their labor market mobility and contributions to local development. Objective: Motivated by recent scholarship that documents poor mental and physical health among Mexican return migrants, this study investigates return migrants' health insurance coverage and access to medical care...
2018: Demographic Research
Andrew K Leung, Lee Hugar, Dattatraya Patil, Lisa Wong, Bradley Carthon, Kenneth Carney, George Birdsong, Kelvin A Moses, Viraj A Master
OBJECTIVE: To characterize men presenting to a tertiary care safety-net hospital with prostate-specific antigen (PSA) values ≥100 ng/mL and identify a potential population for targeted PSA screening. METHODS: Retrospective review of 100 randomly selected patients out of 204 total who presented to Grady Memorial Hospital from 2004-2011 with initial PSA≥100 ng/mL was performed. Demographics, disease characteristics, and survival status were obtained via the Tumor Registry and a combination of electronic medical records and older paper charts, with missing data from paper charts excluded on analyses...
April 12, 2018: Urology
J Y Shin, J K Yoon, A K Shin, A Z Diaz
The purpose of this study was to determine the influence of insurance status on treatment and outcomes in oral cavity cancer. Patients were identified in the National Cancer Database (NCDB). Data were collected and analyzed using χ2 tests, Kaplan-Meier methods, and multivariable Cox regression models. Those uninsured or on Medicaid were more likely to be younger (P<0.001), minority race (P<0.001), have a lower median household income (P<0.001), lower educational attainment (P<0.001), not undergo primary resection (P<0...
April 11, 2018: International Journal of Oral and Maxillofacial Surgery
Igna Bonfrer, Ellen Van de Poel, Emily Gustafsson-Wright, Eddy van Doorslaer
Interventions aiming to simultaneously improve financial protection and quality of care may provide an important avenue towards universal health coverage. We estimate the effects of the introduction of the Kwara State Health Insurance program in Nigeria on not only the insured but also the uninsured. A subsidized voluntary low cost health insurance was offered by a private insurer as well as a quality upgrade in selected health care facilities. Using propensity score matching and panel data collected in 2009 and 2011 (n = 3509), we find that, for the insured, the program increased health care utilization (36 percent, p < 0...
April 3, 2018: Social Science & Medicine
Jenny Hutchison, Michael E Thompson, Jennifer Troyer, Christine Elnitsky, Maren J Coffman, M Lori Thomas
BACKGROUND: Free clinics are volunteer based organizations that provide health care services to low-income individuals for free or minimal cost. Communities served by a free clinic can provide ambulatory care services for uninsured individuals, reducing reliance on costly hospital admissions for ambulatory care sensitive conditions. This study examines whether free clinics in North Carolina reduce hospitalizations for ambulatory care sensitive conditions for uninsured adults. METHODS: The study used North Carolina hospital discharge data from 2003 to 2007, restricted to uninsured adults residing in North Carolina (N = 270,325)...
April 12, 2018: BMC Health Services Research
T L Finlayson, P Asgari, E Dougherty, B K Tadese, N Stamm, A Nunez-Alvarez
OBJECTIVE: To identify associations between child, caregiver, and family-level factors and child dental utilization. RESEARCH DESIGN: Cross-sectional oral health survey. PARTICIPANTS: Caregivers and one study child (ages 0-17) from Mexican migrant families in northern San Diego county, CA (n=142). METHODS: Caregivers reported on child's dental care utilization history and related factors, including: child (age, gender, dental insurance, source of care, believed to have cavities), caregiver (marital status, income, education, acculturation level, depressive symptoms), and family cohesion...
April 12, 2018: Community Dental Health
Jordan H Rhodes
BACKGROUND: The onset of Medicare eligibility at age 65 in the U.S. is accompanied by significant changes in health insurance coverage rates. This presents a unique opportunity to study the interaction among health insurance, health care utilization, and health outcomes. AIMS: This study examines if changes in mental health outcomes accompany the changes in health insurance coverage rates at age 65. METHODS: 2006-2013 data from the Sample Adult and Person File components of the National Health Insurance Survey are used to explore the link between the onset of Medicare and the utilization of mental health care services and mental health...
March 1, 2018: Journal of Mental Health Policy and Economics
Stephen Jan, Tracey-Lea Laba, Beverley M Essue, Adrian Gheorghe, Janani Muhunthan, Michael Engelgau, Ajay Mahal, Ulla Griffiths, Diane McIntyre, Qingyue Meng, Rachel Nugent, Rifat Atun
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation...
April 4, 2018: Lancet
Nancy McClung, Jill Glidewell, Sherry L Farr
OBJECTIVE: To examine the financial burdens and mental health needs of families of children with special healthcare needs (CSHCN) with congenital heart disease (CHD). METHODS: Data from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were used to examine parent-reported financial burdens (out-of-pocket expenses, financial problems, employment impact, caregiving hours) and family members' need for mental health services in families of CSHCN with CHD...
April 6, 2018: Congenital Heart Disease
Dianne Pulte, Lina Jansen, Hermann Brenner
BACKGROUND: Colon cancer is a common cancer with a relatively high survival for nonmetastatic disease if appropriate treatment is given. A lower survival rate for patients with no or inadequate insurance has previously been documented, but the differences have not been explored in detail on a population level. OBJECTIVE: The purpose of this study was to examine survival for patients with colon cancer by insurance type. DESIGN: Complete analysis was used to examine 1-, 2-, and 3-year survival rates...
May 2018: Diseases of the Colon and Rectum
Abdulwahab A Alkhamis, Shaima S Ali Miraj
Objectives: The objectives were to determine whether employment-related factors had influence on physical and mental health outcomes among uninsured expatriates working in Saudi Arabia and to identify whether these factors act as facilitators or barriers to health. Methods: Cross-sectional face-to-face interviewsusing previously published methodswere conducted among a multistage stratified cluster sample of 1370 employees as their problemsin seeking health benefits have notbeen studied...
January 2018: International Journal of Health Sciences
Lizheng Shi, M Kristina Wharton, Alisha Monnette
OBJECTIVES: Federally qualified health centers (FQHCs) are essential to underinsured populations in the safety net by offering them several means of access to reduced cost medications. This study employed a 2-pronged approach to evaluate FQHCs' role, estimating both the need for patient assistance and the impact of the safety net. STUDY DESIGN: A multiyear panel data study for post-Affordable Care Act (ACA) years 2012 to 2016 and a 2016 cross-sectional analysis design were utilized to analyze FQHCs, their patient populations, and prescription assistance programs...
March 2018: American Journal of Managed Care
Anna L Goldman, Danny McCormick, Jennifer S Haas, Benjamin D Sommers
Descriptive studies have suggested that the Affordable Care Act's (ACA's) health insurance Marketplaces improved access to care. However, no evidence from quasi-experimental studies is available to support these findings. We used longitudinal survey data to compare previously uninsured adults with incomes that made them eligible for subsidized Marketplace coverage (138-400 percent of the federal poverty level) to those who had employer-sponsored insurance before the ACA with incomes in the same range. Among the previously uninsured group, the ACA led to a significant decline in the uninsurance rate, decreased barriers to medical care, increased the use of outpatient services and prescription drugs, and increased diagnoses of hypertension, compared to a control group with stable employer-sponsored insurance...
April 2018: Health Affairs
Adele Shartzer, Fredric Blavin, John Holahan
We assessed rates of employer health insurance offer, take-up, and coverage in June 2013 and March 2017 among workers. Overall, offer rates remained stable, and take-up and coverage rates increased. In Medicaid expansion states, the share of workers with family incomes at or below 138 percent of the federal poverty level who had employer-based coverage held steady, while uninsurance rates declined.
April 2018: Health Affairs
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